Medicine and Health

You are required to use the diagnosis you selected for the case bellowhypertension and explain a minimum of different 3 diagnostic findings that would be routinely discovered when confirming this diagnosis in hospital.
These may include the results you would expect from Medical Imaging (x-rays), Blood Tests or Urine Studies.
In 500 words or less, please describe the significance of each finding, linking it to the relevant pathophysiology of your chosen diagnosis.

Case : Pulse 100, BP 150/120, Resp 18
The three possible differential diagnoses for this case are:
• Essential hypertension
• Asthma
• Diabetes type II
The most likely diagnosis for this patient is hypertension. According to Bickley, Szilagyi and Bates (2009), normal pulse rate for healthy young adult is 60-100. This patient has a pulse rate corresponding to upper normal limit. According to Madhur et al (2014), a blood pressure of 150/120 mmHg as in this case, is classified as stage 2 hypertension.
Hypertension is a multi factorial disorder. Few factors are:
• Characteristics of vessels
• Fluid volume in the body
• Cellular viscosity of blood
• Neural stimulation
• Diet
•besity
In this patient, the raised blood pressure could be result of essential hypertension while in response to the vessel wall stiffening, the heart rate is normal. Similarly, the respiratory rate is rarely affected because the gaseous chemistry of the blood remains unchanged. However, long standing hypertension and Left Ventricular Hypertrophy (LVH) are deleterious for health and can lead to heart failure (Madhur et al 2014).
It is also noteworthy that hypertension has a genetic preponderance as well. According to Foëx and Sear (2004), the two main factors contributing to hypertension, either simultaneously or individually are increased cardiac output and an increase in peripheral vascular resistance. In geriatric population, the vessel compliance is increased which decreases the elasticity of the vessel due to vessel wall stiffening. There is another reason why patients develop hypertension is because of the autonomic dysfunction either due to coexistent co-morbidity or due to mediator release. Alpha adrenoceptor stimulation leads to increased vascular tone which ultimately increases the total peripheral resistance. The constant rapid and forceful contraction leads to the hypertrophy of the endocardium of the heart giving rise to left ventricular hypertrophy. In some cases, there is involvement of renin-angiotensin system. There is one other reversible cause of hypertension called as renal artery stenosis in which the renal artery is blocked which leads to increased vascular resistance. This raise leads to hypertension (Foëx & Sear 2004).
According to Bickley, Szilagyi and Bates (2009) there is a concomitant increase in the pulse rate when the heart contracts rapidly but in patients who have stiffening of the arterial walls, it is for this reason that there is a very slight affect on the pulse rate. The slight change is evident in this patient with borderline pulse rate. Furthermore, the breathing rate remains unchanged because the cellular chemistry is not changed but hypertension may lead to increased pulmonary perfusion. When the cardiac contractility is increased for chronic period then it may lead to failure of the myocardial muscles which ultimately leads to pooling of blood in the vessels. This pooling causes pulmonary edema along with edema in the periphery (Foëx & Sear 2004).
According to Madhur et al (2014) hyperventilation leads to decreased cardiac contractility while in greater quantities of oxygen, there is constriction of the diameters of great vessels which leads to increase in the systemic blood pressure.

References

Bickley, L., Szilagyi, P. and Bates, B. (2009). Bates’ pocket guide to physical examination and history taking.7th Edition. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins, pp 147-153.
Foëx, P. and Sear, J. (2004). Hypertension: pathophysiology and treatment: Table 1. ContinEducAnaesthCrit Care Pain, volume 4, pp.71-75. Available at: http://ceaccp.oxfordjournals.org/content/4/3/71.full [Accessed 9 Mar. 2016].
Madhur, M. et al.(2014). Hypertension: Practice Essentials, Background, Pathophysiology. [online] Emedicine.medscape.com. Available at: http://emedicine.medscape.com/article/241381-overview [Accessed 9 Mar. 2016].

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